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A serious threat to progress: World Health Organization warns of sharp rise in rate of HIV and tuberculosis co-infections in Europe

23 March 2017

Testing all patients is vital if the proportion of HIV co-infections is to fall in the European Union and European Economic Area, the World Health Organization has announced ahead of World TB Day 2017.

The proportion of people in Europe living with tuberculosis (TB) and HIV co-infection rose by 40% between 2011 and 2015, driven by a sharp increase in the number of co-infections in Russia, Eastern Europe and Central Asia.

The World Health Organization (WHO), which co-published the figures ahead of World Tuberculosis Day on Friday (24 March), said testing all TB and HIV patients for co-infection is key to halting the increase, which contrasts with a fall in TB deaths and new cases of TB across 53 European countries.

Nearly 182,000 people with TB were also screened for HIV in 39 countries, representing more than 88% of TB patients across the continent as part of WHO surveillance.

It found that a total of 16,380 TB cases also had HIV-positive status. Despite the co-infection rate decreasing across the WHO’s European Union and European Economic Area (EU/EEA), from 5.9% to 4.6%, the figures for the 23 countries outside of the area – including Russia and Ukraine – caused a marked rise in the overall proportion of co-infections, from 5.5% in 2011 to 9% in 2015.

In Russia, around 10% of people with TB are thought to be living with HIV, and 22% of people in Ukraine who have been newly diagnosed with TB or relapsed also have HIV.

There was a significant overlap of the epidemics in these and other countries – Latvia, Malta, Portugal and Estonia also all reported an HIV prevalence of more 10% among people living with TB.

The absolute number of co-infection cases continued to rise in the WHO European region, as it has done with an average annual increase of 13.1% since 2011. Latvia recorded the highest proportion of co-infections, at 26%.

Rapid detection and appropriate treatment are vital for people living with co-infection, but the report shows that only two-thirds of the estimated 27,000 TB/HIV patients were detected in 2015.

Although the number of new TB cases in Europe has constantly fallen since 2002, the current annual decrease of 5% needs to double if the target of ending TB is to be met.

“The general downward trend in reported TB cases is encouraging, but some groups are not benefiting from this trend,” said Dr Andrea Ammon, the ECDC Acting Director. “We need to target our efforts better if we want to end the TB epidemic.

“Although we know about the challenges of TB/HIV co-infection, for two out of three TB patients the essential information on their HIV status was not reported in 2015. We need to get better at this.”

Antiretroviral treatment (ART) coverage for people living with HIV/TB co-infection fell well short of the WHO target of universal coverage in Europe – just 62% accessed treatment in 2015, up from 59% in 2014.

Only eight of the 18 countries in Europe designated as being high-priority, in which about 85% of the estimated TB cases in the European region are found, achieved ART coverage of more than 75%. Only 59% of people in Ukraine were receiving therapy.

The WHO is targeting a 75% treatment success rate among patients with multi-drug-resistant tuberculosis (MDR TB), in which TB becomes resistant to multiple first-line medications.

Nine of the ten countries with the highest MDR TB burden in the world are in Europe, with an estimated 120,000 cases in 2015. The WHO estimates that around 74,000 cases would be detected if patients were tested for drug resistance at an early stage.

The proportion of TB cases among prisoners, who are more likely to be affected by drug-resistant strains or HIV co-infection, was found to be 24 times higher than the general population, with nearly 6% of reported new and relapse TB cases in Europe coming from prisons.

The TB epidemic in Europe peaked in 2001, but Dr Zsuzsanna Jakab, the WHO Regional Director for Europe, warned that TB/HIV co-infections and MDR TB “seriously threaten progress”.

“One in three people co-infected with TB/HIV do not know about their status, which drastically lowers their chances of being cured,” she said.

“In turn, this favours the spread of the diseases, putting health systems and governments under pressure.”